1.2 ELIGIBILITY FOR EMPLOYEES
An Employee becomes a Participant and is eligible as an Active Employee for Health and Welfare benefits described in this Booklet – medical, prescription drug, vision, and dental programs, time loss benefits, life insurance, dependent life insurance, and accidental death and dismemberment benefits – if the Employee:
- is an Employee of a Contributing Employer working pursuant to a Collective Bargaining Agreement or Written Agreement that requires contributions to the Trust on behalf of the Employee, and
- for a period of six consecutive Payroll Months or less, his Dollars Bank account is credited with employer contributions equal to at least the monthly cost of coverage at the highest Plan Level.
How an Employee Becomes Eligible for Coverage as an Active Employee
An Employee becomes eligible for coverage as an Active Employee on the first day of the calendar month after a period of six consecutive months or less in which his/her Dollars Bank account is credited with employer contributions equal to at least the monthly cost of coverage at the highest Plan Level.
An Active Employee who has met the initial eligibility requirements will be automatically enrolled in Employee-Only coverage. Enrollment of a spouse and/or children under the Employee-Plus or Family coverage levels requires a timely and properly-completed enrollment form. Otherwise, the Eligible Employee will remain enrolled in Employee-Only coverage until a change at the Plan’s next Open Enrollment or(if available) a change at Special Enrollment. Enrollment forms are available online and from the Trust Customer Service Office.
Continuation of Eligibility as an Active Employee
An Active Employee will continue to be eligible for benefits as an Active Employee in one of two ways.
First, an Active Employee’s coverage will automatically be continued to the next month if, as of the 25th day of a month in which he has coverage as an Active Employee, his Dollars Bank account contains sufficient employer contributions to pay for the following month’s coverage at his Plan Level. This payment from your Dollars Bank will be made automatically and is mandatory (except for certain members covered by the Uniformed Service Employment and Reemployment Rights Act).
Second, an Active Employee can continue coverage if, as of the 25th day of a month in which he has coverage as an Active Employee his Dollars Bank account contains at least $300 in properly-credited Employer contributions, and no later than the 10th day of the following month he makes a self-payment of the difference between the amount in his Dollars Bank account and the monthly cost of coverage for his Plan Level. (Please contact the Trust Office for details regarding approved methods of payment.) Any amount in your Self-Payment Account as of the 25th of the month will be automatically applied toward the difference between the cost of coverage at your Plan Level and the amount in your Dollars Bank account at that date.
An Employee who does not qualify for continued eligibility as an Active Employee will be eligible to elect COBRA continuation coverage, as specified in Section 14. The continuation of eligibility rules in this section regarding Active Employees do not apply to Employees or their family members who are eligible based on COBRA continuation coverage.